| NPI | 1871029116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 70627-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 67497) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2021-07-12 |